Registration

Student's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

What Session(s) Will Your Child Be Attending?

12/28 Basics and Conditioning

12/29-12/31 Tumbling Camp

Monthly Tumbling Class

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Photo Release *

I hereby grant to Lewiston/Grand Island Dance Centers’ the right to photograph my dependent and use the photo and or other digital reproduction of him/her for publication and advertising processes, whether print, digital or electronic publishing via the Internet.

Yes

No

Liability Release *

Lewiston Dance Inc. Hold Harmless Agreement In consideration for my child being permitted to participate in the Lewiston Dance Inc. program (referred to as “Lewiston/ GI Dance Centers”), I/Wethe parent(s) and/or legal guardian(s) of the dancer agree to the following provisions: Acknowledgment of Risks: I/We understand that there are numerous risks associated with participating in dance activities, including those risks present during classes and activities, on the premises before, during, and after various classes and events, as well as in travel to and from the Lewiston/ GI Dance Centers and various venues of performance. Some of the specific risks include the placement of unusual stresses on the body, falls and tripping which may lead to accidents resulting in, but not limited to, mild to severe bodily injury. I am aware of the [highly] contagious nature of [bacterial and viral diseases including] [the 2019 novel coronavirus disease (COVID-19)/[OTHER INFECTIOUS DISEASE(S)] ([collectively,] the "Disease") and the risk that I may be exposed to or contract the Disease [or other infectious diseases] by being on the Premises and engaging in the Activity. I understand and acknowledge that such exposure or infection may result in serious illness, personal injury, permanent disability, death, or property damage. I/We understand that the Lewiston/ GI Dance Centers cannot be responsible for any injuries or damages experienced by my/our child during her/his participation in Lewiston/GI Dance Center activities. Medical Care: In an emergency situation, when parental permission is not available, I/We hereby grant and give my/our permission for a staff member at the Lewiston/ GI Dance Centers to seek emergency medical treatment for my/our child. Media Relations: By signing the Agreement and Releases, I/We consent and give permission to the Lewiston/ GI Dance Centers, and those acting under its authority, to use the name or likeness of my child for the purpose of marketing the studio to the media. Release, Covenant Not to Sue, Waiver of Liability and Indemnification Provisions Parents (of Minors): I/We have read and clearly understand the terms of this Agreement. I/We give my/our permission for my/our child to participate in all Studio activities, including those described above. I/We also release and hold harmless the Studio, its officers, directors, agents and employees, and those acting under its authority, from all actions, claims and liabilities relating to my/our child’s participation in any and all programs. I further agree to indemnify and hold harmless and defend Lewiston Dance Inc., its teachers, officers, agents, and employees from injuries, damages and losses sustained by me or my child arising out of, connected with, or in any way associated with the activities of the program(s). I have read and fully understand the above program details and waiver and release of all claims.

Yes